Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations

Abstract

In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.

Learning lessons from the 2011 Van Earthquake to enhance healthcare surge capacity in Turkey

“…In reality, the problem of surge capacity is much more complex and includes at least three essential elements; continuous supplies, sufficient number of healthcare professionals, and infrastructure with appropriate medical equipment (Hammond, 2005, Barbisch and Koenig, 2006, Kaji et al, 2006, Christian et al, 2008.…”

Chemical Oxygen Generation

“…8,50 There is little appreciation for the volume of oxygen used in typical healthcare settings. 8,51,52 Large liquid oxygen storage tanks used by hospitals deliver oxygen through copper piping at 50 psi. Supplying 4 L/min of oxygen to 100 patients would utilize 576,000 L of oxygen per day.…”

Scarce Resources for Nuclear Detonation: Project Overview and Challenges

“…This work builds on previous contributions that focused on scarce resources in pandemic influenza. These include a series of articles in Chest, [23][24][25][26][27] 30 which ASPR developed in collaboration with the Agency for Healthcare Research and Quality and others. Many of the principles in this special issue pertain to scarce resource situations in general, but these articles address issues specific to the unique characteristics of a nuclear detonation.…”

“…The importance of these groups is to make proactive triage decisions and to remove the decisions about resource allocation and triage for individual patients from the hands of their treating physician(s). 2,23 Challenges…”